Multimodal Pain Management With Adductor Canal Block Decreases Opioid Consumption Following Total Knee Arthroplasty
Background: Ease of access to opioids in the perioperative period is a risk factor for subsequent opioid misuse. The purpose of this study was to quantify a decrease in opioid consumption following implementation of a new analgesic protocol after total knee arthroplasty (TKA).
Methods: A retrospective cohort study was performed analyzing patients who underwent TKA at a US Department of Veterans Affairs medical center. Patients were divided into 2 groups by multimodal analgesic regimen: Analgesia with intraoperative general anesthesia, a patient-controlled analgesia pump, and oral opioids (control group) or analgesia with intraoperative spinal anesthesia, a multimodal medication regimen, and an adductor canal block (protocol group).
Results: A total of 533 TKAs were included. The mean (SD) IV morphine equivalent dose (MED) requirement was 178.2 (98.0) for the control and 12.0 (24.6) for the protocol group ( P < .001). Total mean (SD) opioid MED requirement was 241.7 (120.1) for the control group and 74.8 (42.7) for the protocol group ( P < .001). The protocol group required only 6.7% of the IV opioids and the control group 30.9%. No difference in oral opioid requirements was found ( P = .85). The control group required more opioid refills at the first postoperative visit ( P < .001).
Conclusions: The described analgesic protocol resulted in significant decreases in IV and total opioid requirement, and lower rates of opioid prescriptions at the first postoperative visit. These findings demonstrate a decrease in opioid utilization with modern perioperative analgesia protocols and reinforce multiple recommendations to decrease opioid exposure and access.
Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Soehnlen, N. T.,
Erb, E. D.,
Froehle, A. W.,
& Krishnamurthy, A.
(2021). Multimodal Pain Management With Adductor Canal Block Decreases Opioid Consumption Following Total Knee Arthroplasty. Federal Practitioner, 38 (12), 598-605.